Radiographic Aids in the

Diagnosis of Periodontal Disease

Dr. Jeff Carlson
Radiographic Aids in the Diagnosis of
Periodontal Disease
Adjunct to clinical examination, not a substitute for it.
Radiographs fail to detect the earliest signs (cellular
changes) of periodontal disease.
Underestimate degree of osseous support lost.
Reveal alterations in calcified/hard tissues only. Do not
show soft tissue changes/pockets. Do not show historical
changes in calcified tissues (over-treatment concerns?).
Difficult to standardize and 2-dimensional.
Adjunct for determining diagnosis, prognosis, and
treatment plan.
Even though radiographs are adjunctive, they are a
necessity for accurate diagnosis and treatment decisions.
Periodontal (Dental) Criteria for
Accurate Radiographs
Show tips of molar cusps with minimal
occlusal surface showing
Enamel caps and pulp chambers should
be distinct
Interproximal spaces should be open
Proximal contacts should not overlap
unless tooth position dictates otherwise
Normal Osseous Structure
Remember biological width principals.
Periapical radiograph has a tendency to distort the distance
between the alveolar crest and CEJ vs a bitewing radiograph
Better interpretive accuracy
with bitewing vs periapical
Dr. Jeff Carlson
Periodontology I
Summer Semester, 2009
School of Dentistry
University of Minnesota
1 of 7
Horizontal Bitewings
Osseous crest is not visible
Horizontal vs. Vertical Bitewing
Vertical bitewings generally more
informative than horizontal bitewings
in detecting moderate to severe
periodontal disease
Paralleling Devices
Bone Destruction in Periodontal
Disease
As a general rule, bone (attachment) loss is always
greater than it appears in the radiographic.
Amount-Distribution of Bone Loss
Amount (percentage) of bone loss and
distribution of bone loss
Pattern of Bone Destruction -
Generalized Horizontal Bone Loss
Bone loss parallel to adjacent CEJs
Dr. Jeff Carlson
Periodontology I
Summer Semester, 2009
School of Dentistry
University of Minnesota
2 of 7
Angular (Vertical) Bone Loss
Bone loss angular to adjacent CEJs
Radiographic Appearance of
Periodontal Disease
Periodontitis
Fuzziness and break in continuity of lamina dura, wedge shaped
radiolucent areas, height of interdental septum is reduced
Normal
Early
Severe-
Advanced
Crestal Continuity
Lack of definitive cortical
crest of bone (lamina dura)
may be indicative of disease
activity
Definitive radiopaque
cortical crest (lamina
dura) indicative of
stability/health
Interdental Craters
Intrabony Pockets
Furcation Involvement (F2 or F3)
Pocket depth (and/or recession) + radiolucency = furcation involvement II or III
Dr. Jeff Carlson
Periodontology I
Summer Semester, 2009
School of Dentistry
University of Minnesota
3 of 7
Whenever there is marked bone loss on a molar
root, it should be assumed the furcation is involved
Osteosarcoma
Periodontal abscess Probe/Gutta Percha Placement
Aggressive Periodontitis
Year 0
Year 4
Dr. Jeff Carlson
Periodontology I
Summer Semester, 2009
School of Dentistry
University of Minnesota
4 of 7
Trauma from Occlusion-Widened
PDL Space
Indicative of tooth
mobility; fremitus or
occlusal trauma
Additional Radiographic Criteria
Facial and/or lingual
osseous surfaces
Prominent vessel
canals
Periapical (Endo-Perio) Lesions
Which comes first? Endo or perio? (treat endo before perio)
Dr. Jeff Carlson
Periodontology I
Summer Semester, 2009
School of Dentistry
University of Minnesota
5 of 7
Decay-Subgingival Calculus
Decay
Subgingival Calculus
Impacted Teeth
Bone response/regeneration remains
questionable after extraction; younger
patients more likely to regenerate bone
than older patients
Root Length/Morphology
Following orthodontic treatment-etiology unknown
Foreign Objects
Cement or impression material in
furcation (F2 or F3)
Lateral Periodontal Cyst
Differential diagnosis may be difficult
without a biopsy
Dr. Jeff Carlson
Periodontology I
Summer Semester, 2009
School of Dentistry
University of Minnesota
6 of 7
Lateral periodontal cyst
Keratocystic odontogenic cyst
Periodontal
abscess
Lateral
radicular
cyst
Skeletal/Systemic Anomalies
Pagets Disease
Fibrous dysplasia
Gauchers Disease
Scleroderma
Digital Intraoral Radiography
A. Contrast
adjustable
B. Full grey scale
C. Sharpness
adjustable
D. Invert Feature
E. Zoom ability
F. Caries detection
enhanced
When to take Radiographs
Bitewings every 1-3 years.
Full-mouth every 4-7 years.
Depends on caries and periodontal
susceptibility of the patient- clinical
judgment-clinical signs/symptoms.
Bitewings are most often taken at
periodontal recalls. (vertical vs.
horizontal?)
Science Transfer
Interpretation of radiographic images of
periodontal disease should be coupled
with clinical findings because great
variation in the images results from
technical factors.
Dr. Jeff Carlson
Periodontology I
Summer Semester, 2009
School of Dentistry
University of Minnesota
7 of 7